| Low Pulsatility Index on Transcranial Doppler Predicts Symptomatic Large Vessel Vasospasm After Aneurysmal Sub-Arachnoid Hemorrhage. | |
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MedLine Citation:
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PMID: 22089755 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Elevated mean cerebral blood flow velocity (mCBFV) on transcranial doppler predicts vasospasm of the large intracranial arteries after aneurysmal Subarachnoid Hemorrhage (aSAH). The Pulsatility Index (PI) is a measure of distal vascular resistance, which may be low when there is compensatory distal vasodilatation following hypoperfusion caused by large vessel vasospasm. OBJECTIVE: To study the predictive value of low PI for symptomatic large vessel vasospasm (SLVVS) after aSAH. METHODS: Medical records of patients admitted with aSAH between January 2007 and April 2009 were reviewed. Transcranial Color-CodedDuplex (TCCD)sonographywas performed daily between days 2-14. Patients with unexplained acute neurological decline underwent catheter- or CT- angiography. The lowest recorded PI and the highestmCBFV on TCCD were correlated to the occurrence of SLVVS, angiographic vasospasm and delayed cerebral infraction in multivariate analysis using logistic regression. Functional outcome was assessed at first follow-up. RESULTS: Eighty-one patients met inclusion criteria. Mean lowest P.I. was 0.71 +0.19. Median highest mCBFV was 135 cm/s (IQR 99-194cm/s). SLVVS was seen in 21 /81 (26%) patients while27/55 (49%) patients with repeat angiography had moderate or severe angiographic vasospasm. Following multivariate analysis, only the lowest PI was an independent predictor of SLVVS (P=0.03, OR 0.04, 95%CI 0.001-0.54) while only the highest mCBFV was an independent predictor of angiographic vasospasm(P=0.02, OR 1.01, 95%CI 1.002-1.02). SLVVS was independently associated with functional outcome at follow-up. CONCLUSION: Low PIon TCCD is an independent predictor of SLVVS after aSAH, while mCBFV is a better predictor of angiographic vasospasm. |
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Authors:
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Venkatakrishna Rajajee; Jeffrey J Fletcher; Aditya S Pandey; Joseph J Gemmete; Neeraj Chaudhary; Teresa L Jacobs; B Gregory Thompson |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-14 |
Journal Detail:
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Title: Neurosurgery Volume: - ISSN: 1524-4040 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-17 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Departments of Neurosurgery and Neurology, University of Michigan 2Department of Neurosurgery, University of Michigan 3Department of Radiology, University of Michigan. |
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